Usefulness of Early Videofluoroscopic Swallowing Study in Acute Stroke Patients With Dysphagia

Abstract

Objective: To demonstrate the usefulness of early videofluoroscopic swallowing study (VFSS) and to investigate change patterns in dietary methods in stroke patients with dysphagia.

Methods: The VFSS was performed within 7 days of stroke onset in neurologically stable patients. The patients were divided into three groups according to type of brain lesion: cortical lesion (CL), subcortical lesion (SCL), and brainstem/cerebellar lesion (BCL). Based on the VFSS results, this study investigated change patterns in feeding method and discrepancies in the aspiration risk predicted by the Water Swallowing Test (WST) and the VFSS. Complications, such as aspiration pneumonia, were also evaluated.

Results: A total of 163 patients met the inclusion criteria and the VFSS was performed within 7 days of stroke. Patients considered at risk for aspiration (Penetration-Aspiration Scale [PAS] scores of 6 to 8) were found in all three groups using the VFSS (47.5% of the CL group, 59.3% of the SCL group, and 47.9% of the BCL group). After early VFSS, 79.7% of the patients were assessed to require restricted feeding methods. A 19.0% discrepancy was found between the WST and VFSS results. At 3-week follow-up after the VFSS, aspiration pneumonia was observed in 12 patients (7.4%) with restricted feeding methods.

Conclusion: Early VFSS during the acute period can facilitate determination of the most appropriate feeding method, and support effective dysphagia management for stroke patients.

Keywords: Acute stroke; Diet modification; Dysphagia; Early videofluoroscopic swallowing study.

Fig. 1. Dysphagia screening protocol. Patients' feeding methods were determined using the hospital's dysphagia screening protocol within 24 hours of arrival.

Fig. 2. Flowchart of the study design. VFSS, videofluoroscopic swallowing study; NG, nasogastric; MMSE, Mini-Mental Status Examination.